2018-05-15T13:09:11-05:00 2017-06-30 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2016-07-01 311156690 HOLZER HEALTH SYSTEM HOLZ 7404465060 100 Jackson Pike Gallipolis OH 45631 MICHAEL HAYNES CFO 7404465060 2018-05-14 1 Bernie Ostrowski P00366367 6148493000 2018-05-10 2016 2022-09-23 18:48:47Z MICHAEL CANADY 100 Jackson Pike Gallipolis OH 45631 115872113 0 X WWW.HOLZER.ORG X 1985 OH THE PRIMARY EXEMPT PURPOSE OF HOLZER HEALTH SYSTEM IS TO ACT AS THE MANAGING PARENT, SOLE VOTING MEMBER OF THE FOLLOWING 501(C)(3) ENTITIES, WHOSE PRIMARY PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES: HOLZER HOSPITAL FOUNDATION, HOLZER MEDICAL CENTER-JACKSON, HOLZER SENIOR CARE CENTER, HOLZER ASSISTED LIVING-GALLIPOLIS, HOLZER ASSISTED LIVING-JACKSON, HOLZER FOUNDATION AND HOLZER VANGUARD, A FOR-PROFIT SUBSIDIARY (COLLECTIVELY REFERRED TO AS CONSOLIDATED). 22 10 669 10 0 0 0 0 114267547 115232328 7480 256174 20594 19532 114295621 115508034 0 0 0 0 79836089 82827747 0 0 4871 71597506 74973066 151433595 157800813 -37137974 -42292779 167482915 166772470 161605544 155753169 5877371 11019301 FRIENDLY VISITS, EXCELLENT CARE; EVERY PATIENT, EVERY TIME. 0 0 0 0 3277772 HOLZER HEALTH SYSTEM PROVIDED MANAGEMENT SERVICES/REAL ESTATE TO ITS SUBSIDIARIES WHOSE EXEMPT PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES. 1311497 0 1225283 HOLZER DENTAL CLINIC-JACKSON STRIVES TO IMPROVE THE DENTAL HEALTH STATUS OF THE PEOPLE AND COMMUNITIES WE SERVE. 87627692 0 110732954 HOLZER CLINIC, LLC IS A MULTIPLE DISCIPLINE HEALTH CARE SYSTEM OF OVER 143 BOARD CERTIFIED PHYSICIANS PROVIDING CARE IN MORE THAN THIRTY AREAS OF EXPERTISE. 88939189 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 78 0 1 669 1 0 0 0 0 0 0 0 0 0 0 X 22 10 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MICHAEL HAYNES CFO 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 STEVE CHAPMAN CHAIRMAN 1.00 3.00 X X 24000 0 0 BRENT SAUNDERS CHAIRMAN 36.00 4.00 X X 405662 0 1719 LARRY KID TREASURER 1.00 3.00 X X 24000 0 0 DR MICHAEL CANADY CEO 36.00 4.00 X X 353712 0 0 DANNY HOLSCHUH TRUSTEE 1.00 3.00 X 24000 0 0 GARY ROACH TRUSTEE 1.00 3.00 X 24000 0 0 PAUL REED TRUSTEE 1.00 3.00 X 24000 0 0 BOB GRILLO TRUSTEE 1.00 3.00 X 24000 0 0 DR RODNEY STOUT TRUSTEE 39.00 1.00 X 240416 0 0 DR LANCE BROY TRUSTEE 39.00 1.00 X 244075 0 0 DR DANIELLE CAPPELLETTI TRUSTEE 39.00 1.00 X 259570 0 0 DR SCOTT DAVIS TRUSTEE (FROM 1/17) 40.00 0.00 X 0 0 0 DR RENUKA KANDULA TRUSTEE 39.00 1.00 X 338102 0 0 DR PHIL LONG TRUSTEE 39.00 1.00 X 908980 0 0 DR JARED SHEETS TRUSTEE 39.00 1.00 X 411433 0 0 DR LOUIS WICKAS TRUSTEE (FROM 1/17) 40.00 0.00 X 379064 0 0 JOHN CUNNINGHAM TRUSTEE 40.00 0.00 X 317214 0 0 STEPHEN DOYLE TRUSTEE 40.00 0.00 X 150968 0 0 TODD FOWLER TRUSTEE 40.00 0.00 X 291990 0 0 JEREL HUMPHREY TRUSTEE (THROUGH 12/16) 40.00 0.00 X 324081 0 0 BRAD MUNN TRUSTEE 1.00 3.00 X 24000 0 0 ROBBIE PUGH TRUSTEE 1.00 1.00 X 0 0 0 TOM WISEMAN TRUSTEE 1.00 3.00 X 24000 0 0 MICHAEL HAYNES CFO 36.00 4.00 X 167030 0 0 DR FEGUENS BATAILLE PHYSICIAN 40.00 0.00 X 1153782 0 0 DR ROBERT BRADLEY PHYSICIAN 40.00 0.00 X 925984 0 0 DR STEVEN CONLEY PHYSICIAN 40.00 0.00 X 918788 0 0 DR DEAN SICILIANO PHYSICIAN 40.00 0.00 X 882542 0 0 DR MEHRDAD ASGERI PHYSICIAN 40.00 0.00 X 826258 0 0 DR CHRISTOPHER MEYER CEO- HHS 36.00 4.00 X 546751 0 0 DAN JANICAK CFO- HHS 39.00 1.00 X 351693 0 0 10590095 0 1719 178 1 1 0 OHIO VALLEY PHYSICIANS INC PO BOX 390 HUNTINGTON WV 25708 EMERGENCY DEPT. STAFFING 13463811 PRECYSE SOLUTIONS LLC 1275 DRUMMERS LANE SUITE 200 WAYNE PA 19087 MEDICAL CODING & MANAGEMENT SERVICES 2878003 COMFORCE 3492 MOMENTUM PLACE CHICAGO IL 606895334 MEDICAL CODING SERVICES 1548271 3M PO BOX 371227 PITTSBURGH PA 152507227 MEDICAL CODING SERVICES 858689 B E SMITH DEPARTMENT 300 PO BOX 219241 KANSAS CITY MO 641219241 STAFFING & LEADERSHIP SERVICES 807378 19 Net Patient Service Revenue 621110 111158432 111158432 RENTAL INCOME 531120 3353165 3353165 Management Fees 561000 937570 937570 INVESTMENTS IN JVs 523930 -216839 -216839 115232328 10160 10160 25209 5677 19532 19532 19532 604416 358402 246014 246014 246014 115508034 115232328 0 275706 X 5598000 5598000 64860411 48480085 16380326 8998267 3342414 5655853 3371069 1968111 1402958 3603780 2902153 701627 725099 7400 717699 230310 230310 33392998 16437636 16955362 4871 4871 5367361 3317592 2049769 5440867 52609 5388258 534143 375962 158181 702716 296085 406631 10279777 304138 9975639 3057808 413367 2644441 1571218 1433009 138209 Bad Debt Expense 9185078 9185078 MEDICAL SUPPLIES 420335 416644 3691 PROPERTY TAX 205039 205039 DUES AND MEMBERSHIPS 176578 176578 75088 6906 68182 157800813 88939189 68856753 4871 8337829 10231497 20104917 20399965 1040805 1255588 97645060 19094693 80899525 78550367 5658138 4445839 1560730 1043933 3904000 3904000 18812055 18812055 27164916 28129226 167482915 166772470 30564131 27301853 124533323 119171642 2858211 4048385 3649879 5231289 161605544 155753169 X 5877371 11019301 5877371 11019301 167482915 166772470 X -42292779 47434709 X X 0 1 X 1 0 X X 4 HOLZER HOSPITAL FOUNDATION 314379491 3 1 0 0 HOLZER MEDICAL CENTER-JACKSON 311724085 3 1 0 0 HOLZER SENIOR CARE CENTER 311534051 10 1 0 0 HOLZER HERITAGE FOUNDATION 310927482 7 1 0 0 4 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 SCHEDULE A, PART 1, LINE 11: HOLZER HEALTH SYSTEM PROVIDES ADMINISTRATIVE SUPPORT SERVICES TO RELATED ORGANIZATIONS. SCHEDULE A, PART IV, SECTION E, LINE 3A: HOLZER HEALTH SYSTEM IS THE SOLE MEMBER OF EACH OF ITS SUPPORTED ORGANIZATIONS. SCHEDULE A, PART IV, SECTION E, LINE 3B: DECISIONS MADE BY THE BOARD OF DIRECTORS OF EACH SUPPORTED ORGANIZATION CAN BE OVERRULED BY THE BOARD OF DIRECTORS OF HOLZER HEALTH SYSTEM. SCHEDULE A, PART IV, SECTION D, LINE 3: HOLZER HEALTH SYSTEMS' BOARD OVERLAPS WITH THE BOARD OF THE SUPPORTING ORGANIZATION. THIS OVERLAP CAUSES THE SUPPORTED ORGANIZATION TO HAVE A SIGNIFICANT VOICE OVER THE HOLZER HEALTH SYSTEMS. 6699795 6699795 85025382 16800710 68224672 5495079 2293983 3201096 424804 424804 78550367 RELATED PARTY RECEIVABLES 10866566 FUNDS HELD BY TRUSTEES UNDER BOND INDENTURE 17262660 28129226 Related Party Payables 5231289 5231289 X X 1 0 0 0 0 0 0 0 0 BRENT SAUNDERS CHAIRMAN 405662 0 0 0 0 0 1719 0 0 0 407381 0 0 0 DR MICHAEL CANADY CEO 353712 0 0 0 0 0 0 0 0 0 353712 0 0 0 DR RODNEY STOUT TRUSTEE 240416 0 0 0 0 0 0 0 0 0 240416 0 0 0 DR LANCE BROY TRUSTEE 244075 0 0 0 0 0 0 0 0 0 244075 0 0 0 DR DANIELLE CAPPELLETTI TRUSTEE 259570 0 0 0 0 0 0 0 0 0 259570 0 0 0 DR RENUKA KANDULA TRUSTEE 338102 0 0 0 0 0 0 0 0 0 338102 0 0 0 DR PHIL LONG TRUSTEE 908980 0 0 0 0 0 0 0 0 0 908980 0 0 0 DR JARED SHEETS TRUSTEE 411433 0 0 0 0 0 0 0 0 0 411433 0 0 0 DR LOUIS WICKAS TRUSTEE (FROM 1/17) 379064 0 0 0 0 0 0 0 0 0 379064 0 0 0 JOHN CUNNINGHAM TRUSTEE 317214 0 0 0 0 0 0 0 0 0 317214 0 0 0 STEPHEN DOYLE TRUSTEE 150968 0 0 0 0 0 0 0 0 0 150968 0 0 0 TODD FOWLER TRUSTEE 291990 0 0 0 0 0 0 0 0 0 291990 0 0 0 JEREL HUMPHREY TRUSTEE (THROUGH 12/16) 324081 0 0 0 0 0 0 0 0 0 324081 0 0 0 MICHAEL HAYNES CFO 167030 0 0 0 0 0 0 0 0 0 167030 0 0 0 DR FEGUENS BATAILLE PHYSICIAN 1153782 0 0 0 0 0 0 0 0 0 1153782 0 0 0 DR ROBERT BRADLEY PHYSICIAN 925984 0 0 0 0 0 0 0 0 0 925984 0 0 0 DR STEVEN CONLEY PHYSICIAN 918788 0 0 0 0 0 0 0 0 0 918788 0 0 0 DR DEAN SICILIANO PHYSICIAN 882542 0 0 0 0 0 0 0 0 0 882542 0 0 0 DR MEHRDAD ASGERI PHYSICIAN 826258 0 0 0 0 0 0 0 0 0 826258 0 0 0 DR CHRISTOPHER MEYER CEO- HHS 416829 0 0 0 129922 0 0 0 0 0 546751 0 0 0 DAN JANICAK CFO- HHS 252421 0 0 0 99272 0 0 0 0 0 351693 0 0 0 Part I, Line 4a DURING THE YEAR CHRISTOPHER MEYER AND DAN JANICAK RECEIVED SEVERAL INSTALLMENT PAYMENTS FOR SEVERANCE TOTALING $129,921 AND $99,272 RESPECTIVELY. A COUNTY OF GALLIA OHIO- BONDS SERIES 2012 A20 316400068 36381PAP2 2012-03-27 155315000 SEE SCHEDULE O 0 0 0 A 155315478 10991785 3087477 106281906 3817000 2012 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 1 SCHEDULE K, PART I DESCRIPTION OF PURPOSE: (A) CURRENTLY REFUNDED THE ENTITY'S (I) SERIES 1998 BONDS ISSUED ON OCTOBER 1, 1998; (II) SERIES 2009 BONDS, ISSUED ON NOVEMBER 3, 2009, WHICH WERE A REISSUANCE OF THE SERIES 2005 BONDS ISSUES ON MARCH 10, 2005; AND (III) VARIOUS TAXABLE OBLIGATIONS; AND (B) ACQUISITION OF HOSPITAL FACILITIES INCLUDING A CLINIC AND FUTURE CAPITAL EQUIPMENT ACQUISITIONS AND FACILITY RENOVATIONS; AND CANCER CENTER PROJECT. Form 990, Part VI, Section A, line 3 STEPHEN DOYLE, CHIEF NURSING OFFICER, WAS EMPLOYED BY B.E. SMITH, A MANAGEMENT COMPANY DURING FISCAL YEAR-ENDED JUNE 30, 2017. STEPHEN RECEIVED COMPENSATION OF $54,870 FROM B.E. SMITH. Form 990, Part VI, Section B, line 11b THE CONTROLLER AND THE CFO REVIEW FORM 990 AND A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. Form 990, Part VI, Section B, line 12c THE ORGANIZATION FOLLOWS THE ADOPTED POLICIES OF HOLZER MEDICAL CENTER- JACKSON AND HOLZER HOSPITAL FOUNDATION, RELATED TAX-EXEMPT ORGANIZATIONS. CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY BY ALL BOARD MEMBERS AND OFFICERS, AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT. Form 990, Part VI, Section B, line 15 THE HOLZER HEALTH SYSTEM BOARD APPROVES COMPENSATION OF THE CEO AND OTHER OFFICERS. THE BOARD UTILIZES WAGE RECOMMENDATIONS FROM AN UNRELATED CONSULTANT TO DETERMINE THE COMPENSATION. THE CEO MAY BE INVOLVED IN DETERMINING OTHER OFFICERS' COMPENSATION, HOWEVER THE ULTIMATE DECISION RESTS WITH THE BOARD. THE PROCESS WAS LAST UNDERTAKEN DURING AUGUST 2016. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY. Form 990, Part IX, line 11g OUTSIDE SERVICES: Program service expenses 16,072,878. Management and general expenses 10,576,182. Fundraising expenses 0. Total expenses 26,649,060. CONTRACT LABOR: Program service expenses 21,891. Management and general expenses 5,957,427. Fundraising expenses 0. Total expenses 5,979,318. FOOD: Program service expenses 12,625. Management and general expenses 161,812. Fundraising expenses 0. Total expenses 174,437. RECRUITMENT: Program service expenses 198,747. Management and general expenses 167,613. Fundraising expenses 0. Total expenses 366,360. DUES AND MEMBERSHIPS: Program service expenses 63,889. Management and general expenses 2,157. Fundraising expenses 0. Total expenses 66,046. LICENSURE FEES: Program service expenses 67,606. Management and general expenses 90,171. Fundraising expenses 0. Total expenses 157,777. Form 990, Part XI, line 9: TRANSFERS TO/FROM AFFILIATES 47,434,709. FORM 990, PART XI, LINE 2C THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, LINE 16 THE ORGANIZATION DOES NOT HAVE IN PLACE A WRITTEN POLICY TO EVALUATE ITS PARTICIPATION IN JOINT VENTURES, HOWEVER IT MAKES SURE TO TAKE THE NECESSARY PRECAUTIONS TO SAFEGUARD ITS TAX-EXEMPT STATUS. IN ADDITION, LEGAL COUNSEL IS CONSULTED BEFORE CONSIDERING A NEW JOINT VENTURE. HOLZER DENTAL CLINIC JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 275346256 HEALTHCARE OH 1225283 2572458 HOLZER HEALTH SYSTEM HOLZER CLINIC LLC 90 JACKSON PIKE GALLIPOLIS OH 45631 310917085 PHYSICIAN PRACTICES OH 110838296 26399722 HOLZER HEALTH SYSTEM HOLZER HERITAGE FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 310927482 CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE OH 501(C)(3) Line 7 HOLZER HEALTH SYSTEM 1 HOLZER MEDICAL CENTER - JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 311724085 HEALTH CARE OH 501(C)(3) Line 3 HOLZER HEALTH SYSTEM 1 HOLZER SENIOR CARE CENTER 380 COLONIAL DRIVE BIDWELL OH 45614 311534051 SKILLED NURSING FACILITY OH 501(C)(3) Line 10 HOLZER HEALTH SYSTEM 1 HOLZER HOSPITAL FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 314379491 HEALTH CARE OH 501(C)(3) Line 3 HOLZER HEALTH SYSTEM 1 HOLZER VANGUARD INC 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH HOLZER HEALTH SYSTEM C 4024721 3970687 1.00000 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1 HOLZER HOSPITAL FOUNDATION L 38976234 ACCRUAL TRANSACTION HOLZER MEDICAL CENTER- JACKSON L 8907928 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION A 557629 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION K 108176 ACCRUAL TRANSACTION